In the ever-evolving landscape of medical practices, the efficient management of medical billing and coding is paramount to success. A seamless billing and coding process not only streamlines daily operations but also significantly impacts the revenue cycle and overall profitability of your practice. Entrusting these critical tasks to an underqualified in-house team can lead to a nightmarish scenario, draining both time and financial resources. Conversely, selecting the wrong medical billing and coding company for outsourcing can be equally vexing. To navigate this complex terrain successfully, we recommend opting for the services of the top medical billing and coding companies in the USA.

Why Outsource Medical Billing?

Outsourcing medical billing and coding has become a cornerstone strategy for thriving medical practices. Collaborating with a professional, credentialed, and experienced medical billing service is a strategic choice within the healthcare industry. This approach not only alleviates the burden on your in-house staff but also ensures maximum reimbursements from patient visits, expediting the payment process. Additionally, outsourcing proves to be a cost-efficient alternative compared to maintaining an in-house billing team, saving your practice both time and financial resources.

Discover more about the nuances of in-house versus outsourced medical billing, examining the distinctive advantages and disadvantages of each.

What to Consider before Choosing a Medical Billing and Coding Service

Selecting the best medical billing and coding service requires a thorough examination of various factors tailored to your practice's unique needs. While online reviews offer valuable insights, understanding your practice's priorities is crucial. To facilitate this decision-making process, ponder over these essential questions commonly raised by practices in search of a suitable billing service:

1. Do you prefer a local company?

When it comes to outsourced medical billing and coding services, you generally have two options – local companies or offshore billers. Opting for a local company is advisable for several reasons. Offshore billers may face challenges comprehending the intricacies of the U.S. insurance system, and communication hurdles may arise, often limited to their support center. Choosing a local company ensures more direct assistance, on-site support, and efficient communication.

2. Do they have experience in your specialty?

Transparency about a billing service's experience in handling billing and coding for your specific medical specialty is crucial. It is imperative to select a service with expertise in your field, avoiding long-term contracts with companies that assign novice billers and coders to your account.

3. What is their payment structure?

Carefully scrutinize the payment structure proposed by the medical billing and coding service. The medical billing industry offers various payment structures, and understanding common practices is essential to align the service with your budget.

Explore more about medical billing fee structures to make an informed decision.

4. Is the price too low?

Exercise caution when encountering medical billing and coding services with seemingly low prices. In the realm of medical billing, you typically get what you pay for. Extremely low rates often signal subpar quality or hidden catches in the fine print, leading to potential issues in revenue cycle management. While cost-effectiveness is crucial, excessively low-cost services may compromise the quality you seek. A reasonable expectation is to pay around 4-7% of your practice's net revenue to a billing partner.

5. Is the contract duration too long?

Beware of medical billing and coding contracts that lock your practice into extended periods. Avoid long-term commitments, especially if you haven't tested the service yet. Standard contract lengths typically range from 1-3 years, with annual renewals contingent on the billing company's satisfactory performance (a "performance guarantee"). Many companies also offer free trials, allowing you to assess the service quality before committing.

5 Best Medical Billing and Coding Services

Navigating the plethora of medical billing and coding services can be challenging due to their apparent similarities. However, certain factors distinguish the best services, including reliability, experience, cost-effectiveness, client reviews, and more. Here are five high-quality medical billing and coding services deserving of consideration:

1. Kareo

Kareo stands out as an increasingly recognized and widely used medical billing and coding services company. Boasting excellent client reviews, Kareo has developed a reliable billing program focused on expediting reimbursements. With over 65,000 practices under its belt, generating $25 billion in claim revenue annually, Kareo provides robust training, quick reimbursements, and competitive pricing for the quality of service.

  • Years of experience: 16 years in business
  • Pricing: 4%-7% of net collections
  • Pros: Robust training, quick reimbursements, great price for quality of service
  • Cons: Limited EHR software and integrations

2. AthenaHealth

AthenaHealth is renowned for its reliability in the medical billing and coding service domain. Operating for 23 years, they bring extensive industry understanding and prioritize HIPAA compliance. While their comprehensive platform is better suited for larger practices and hospitals, they provide exceptional customer support.

  • Years of experience: 23 years in business
  • Pricing: Either flat rate per insurance provider or a percentage of annual collections, whichever is greater
  • Pros: Comprehensive service, 90-day minimum contract, best HIPAA compliant system
  • Cons: May be overly complicated for small practices, can be pricey

3. CureMD

CureMD stands as a favorite billing service among medical practices due to its flexibility and customization options. With over 20 years of experience, CureMD offers an easy-to-navigate EHR software, client support options, and cost-efficiency. However, it's essential to confirm if they support your medical specialty, as not all specialties are covered.

  • Years of experience: 20+ years in business
  • Pricing: About 5% of net collections
  • Pros: Great for small practices, easy to use, included EHR software and patient portal
  • Cons: Not the best solution for large practices and hospitals, some add-on fees, some specialties not supported

4. AdvancedMD

Known for flexibility, AdvancedMD supports a wide range of medical specialties. With over 20 years in the industry, they boast a high "first pass" success rate for claim submissions, ensuring physicians are reimbursed promptly. While offering an easy-to-use interface, it's worth noting that they do not automatically code for you, necessitating an in-house coder.

  • Years of experience: 20+ years in business
  • Pricing: About $729 per provider per month
  • Pros: Many specialties supported, highest success rates in industry, easy to use interface, helps you avoid error
  • Cons: Does not automatically code for you, which means you may need an in-house coder

5. Cerner

Cerner stands as a highly credentialed medical billing and coding service designed to assist larger practices with complex billing needs. With 40 years in business, Cerner handles the entire billing and coding process, relieving in-house operations of significant burdens. While offering a robust platform, there might be a learning curve and training requirements. It's essential to consider that Cerner's pricing is higher than average.